[Repairing chronic osteomyelitis complicated by long bone defect in tibia with free segmented-fibula transplantation].

OBJECTIVE: To probe the repair method and effect of free segmented-fibula transplantation to treat chronic osteomyelitis complicated by long bone defect in tibia in the first intention.

METHODS: From March 1996 to December 2003, 67 cases of chronic osteomyelitis complicated by long bone defect were reconstructed with vascularized fibula graft after the long inflammable bone and soft tissue focus were resected. Their age ranged from 8 to 42 years. The course of disease was 6 months to 8 years. There were 14 cases of hematogenous osteomyelitis and 53 cases of traumatic osteomyelitis. Of them, 18 cases complicated by fracture of fibula; 21 cases by defect of skin (2 cm x 4 cm-4 cm x 10 cm) and bone exposure; 53 cases by pathological fracture and nonunion; and 46 cases by 1-3 fistula of osteomyelitis. The length of bone defect was from 8 cm to 22 cm (mean 12 cm), and the germiculture results of all cases were positive. Forty-six cases were treated with vascularized fibula graft, the other 21 cases with the skin flap. The segmented-fibula was 10-28 cm, skin flap size was 4 cm x 7 cm-6 cm x 12 cm.

RESULTS: After a follow-up of 12-45 months, the healing rate of sinus was 93.5% while the 6.5% remainders healed by the second sinus cleaning-up. The graft bone healed after 4-6 months (mean 4.2 months) by X-ray examination. The limb inflammation was controlled after 2 weeks. All 21 skin flaps all survived and the function recovery of affected limb was 79% of normal limbs according to Enneking evaluation system, but 2 patients occurred secondary fracture. The act or process of augmenting of tibia under 18-year-old cases were sooner than those who were more than 18-year-old.

CONCLUSION: It is a choice to repair the chronic osteomyelitis complicated by long bone defect with vascularized fibula graft in the first intention. The operation to reconstruct long bone defect is a good method to control inflammation efficiently, shorten period of treatment and reduce the time of operation.